Abstract 129: Predicting Neurologic Outcome After Survived Cardiac Arrest and Hypothermic Treatment by Serum-Neuron Specific Enolase
Purpose: NSE (neuron specific enolase) is a well-known blood parameter for quantifying neuronal damage and therefore predicting neurologic outcome after cardiac arrest. However, recent studies showed discrepant results regarding specific time-points of blood sample acquisition and cut-off values of NSE in order to obtain optimal predictive power. We conducted this study by collecting blood samples from patients undergoing therapeutic hypothermia after cardiac arrest in order to define new cut-off values of NSE as well as the time-point of its most predictive power regarding good neurologic outcome.
Methods: Blood samples were collected from patients undergoing therapeutic hypothermia after cardiac arrest either by invasive or external cooling at 7 pre-defined time-points (0, 6, 12, 24, 36, 48 and 72 hours) before and after the onset of hypothermic treatment. One hundred-and-nine patients were included in the study. Neurologic outcome was assessed at hospital discharge (cerebral performance category, CPC). ROC-curves of NSE values were drawn for all time-points in order to determine cut-off values for good neurologic outcome (CPC 1 and 2). Cut-off values of NSE at each time-point were determined by taking the value with the highest sensitivity still showing 100% specificity.
Results: Area under the curve of all ROC-curves increased from time-point to time-point and reached its maximum at 72 hours, which indicates best predictive power regarding good neurologic outcome. Our determined NSE cut-off values were 42.5, 41.0, 43.5, 35.5, 36.5, 46.5 and 29.0 ng/mL for time-points 0, 6, 12, 24, 36, 48 and 72 hours, respectively. Patients with good neurologic outcome all showed a NSE value below the determined cut-off for every time-point.
Conclusions: Neuron specific enolase is a well-known predictor for neurologic outcome after cardiac arrest and cardiopulmonary resuscitation. By including a large number of patients, we could determine a new reliable NSE cut-off value. NSE < 29 ng/mL at 72 hours after the onset of therapeutic hypothermia has the strongest predictive power for good neurologic outcome.
- © 2010 by American Heart Association, Inc.